Active NPI
Samuel Park, DPT
- Physical Therapist
- Milwaukee, WI
National Provider Identifier
1154853836
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 12430
- Practice address
- 5000 W National Ave
Milwaukee, WI 53295-0001 - Phone
- (414) 384-2000
- NPI assigned
- Mar 31, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 12430 | WI | Primary |
Addresses
Primary practice location
5000 W National Ave
Milwaukee, WI 53295-0001
Mailing address
5000 W National Ave
Milwaukee, WI 53295-0001
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12430 | WI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1490918400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1490918400000",
"number": "1154853836",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5000 W NATIONAL AVE",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532950001"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5000 W NATIONAL AVE",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532950001",
"telephone_number": "414-384-2000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "SAMUEL",
"credential": "DPT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-03-31",
"last_updated": "2017-03-31",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WI",
"license": "12430",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Milwaukee, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.